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05-SEPTEMBER-2009  RABAB KHALED MAHAMEED   38 YEARS  ROUND CELL TUMOR OF THE CERVICAL SPINE WITH BILATERAL EXTRADURAL EXTENSION AND INVOLVEMENT OF SOFT TISSUES.

Please! wait for 3-5 min till the video start to load. It depends upon the internet connection.

Anamnesis:

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The patient came to the clinic 02-September-2009 complaining of neck pain for 1 year  with progressive course and cephalic pain right side and radicular pain in the left upper limb for three months.

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On examination: the patient cannot set from supine without help and with agonizing neck pain. She has pain when rotating the neck to all directions and suffer fainting when flexing the neck. She has inability to hold the left arm and weak right deltoid 3/5. All muscles of the upper limb are weak 3/5 more weak in the left side. There is analgesia of the right C3 root territory and hypalgesia of the thumb right hand.

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MRI of the brain was unremarkable, but there is a huge extradural mass extending from the right side of C2 down to C6 and other mass in the left side from C3 down to C5 with involvement of the roots both sides and the muscles of the spine posteriorly and anteriorly. The C4 body was also involved.

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Laminectomy of C3-5 with partial of C2 and C6. The tumor was seen invading the pathologic epidural fat at the right side and adherent to the dural. It was highly vascular. Frozen section revealed round cell tumor mostly Ewing's sarcoma. The extradural mass was removed after coagulating all its mass, because it was consisting of rich cluster of vascular walls. The roots were kept intact after decompression, but it was impossible to remove the part involving the left C3 root, because the root itself was a tumorous. Strict heamastasis.

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Routine closure of the wound and smooth postoperative recovery and the patient sent to the ward.


Comments

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Round cell tumor could be a Ewing's sarcoma  which in this case is an advanced one and radiotherapy combined with chemotherapy will be the last options for the patient.

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The aim of the surgery was to remove compression of the cervical spine so as to prevent eminent quadriplegia.


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